Provider Demographics
NPI:1447484597
Name:ELBA M. PACHECO, M.D., LLC
Entity type:Organization
Organization Name:ELBA M. PACHECO, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELBA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PACHECO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-647-0123
Mailing Address - Street 1:692A RITCHIE HWY
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3971
Mailing Address - Country:US
Mailing Address - Phone:410-647-0123
Mailing Address - Fax:410-647-0126
Practice Address - Street 1:692A RITCHIE HWY
Practice Address - Street 2:SUITE 2B
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3971
Practice Address - Country:US
Practice Address - Phone:410-647-0123
Practice Address - Fax:410-647-0126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD38556207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty